Flexible ureteroscope for management of calyceal diverticulum calculi with ultrasound guided puncture for 16 cases and literature review
ZHANG Ji-qing, KANG Ning, QIU Zhi, ZHANG Jun-hui
Chinese Journal of Clinical Anatomy ›› 2016, Vol. 34 ›› Issue (4) : 460-463.
Flexible ureteroscope for management of calyceal diverticulum calculi with ultrasound guided puncture for 16 cases and literature review
Objective To evaluate the value of flexible ureteroscope (FURS) for management of renal calyceal diverticulum calculi with ultrasound guided punctureof diverticulum. Methods Combined with reviewing the relevant literature, we retrospectively analyzed the clinical data of 16 cases of diverticular calculi. From August 2014 to July 2015, 7 men and 9 women with an median age 48 years among them, 14 patients sustained symptomatic caliceal diverticulum calculi while 2 patients were symptoms free. Those patients were treated by FURS. FURS recognition of diverticulum ostium with ultrasound guided puncturing intodiverticular cavity in lateral lithotomy position was performed. After the needle entered diverticular cavity, saline-diluted methylthioninium chloride was injected or guidewires were inserted gently through needle sheaths. At the same time, the orifice or wall of the diverticular cavity was recognized under FURS. A 200-mm holmium laser fiber was used to incise the stenotic infundibulum or diverticular wall. Diverticular calculi was fragmented and washed out of the diverticulum. Larger fragments were extracted with basket. Results Of the 16 cases, calyceal diverticulum necks leading to calyx were identified in 10 cases, and another 6 cases were not found but their locations were determined. The diverticular walls of the later 6 cases were incised with laser. The stone free rate, fragment success rate and symptom free rate was 75%（12/16）, 87.5%（14/16）and 100%（14/14）, respectively. Two cases underwent repeated procedure for the residual fragments, and the fragments were all cleared successfully after second surgery. Diverticula became disappeared or shrunk in 6 and 10 cases 3 months after the operation, respectively. Conclusion Flexible ureteroscope combined with the ultrasound guided puncture of diverticular cavity for management of caliceal diverticulum calculimay provide a safe and an effective option. Ultrasound guided needle puncture into calyceal diverticulum may facilitate flexible ureteroscopic treatment of calyceal diverticulum calculi.
Calyceal diverticulum / Calyceal diverticulum calculi / Flexible ureteroscope / Percutaneous nephrolithotomy / Puncture / Ultrasound
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